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1.
World Tourism Organization (WTO).  UNWTO World Tourism Barometer: international tourist arrivals. January 2006. http://www.world-tourism.org/facts/menu.html. Accessed March 5, 2006
2.
Leder K, Black J, O’Brien D.  et al.  Malaria in travelers: a review of the GeoSentinel surveillance network.  Clin Infect Dis. 2004;39:1104-111215486832Google ScholarCrossref
3.
Hughes C, Tucker R, Bannister B, Bradley DJ.Health Protection Agency Advisory Committee on Malaria Prevention for UK Travellers (ACMP).  Malaria prophylaxis for long-term travelers.  Commun Dis Public Health. 2003;6:200-20814708269Google Scholar
4.
World Health Organization (WHO).  Malaria.  International Travel and HealthIn: Geneva, Switzerland: WHO; 2005:132-151. http://whqlibdoc.who.int/publications/2005/9241580364_chap7.pdf. Accessed July 14, 2006Google Scholar
5.
Muentener P, Schlagenhauf P, Steffen R. Imported malaria (1985-95): trends and perspectives.  Bull World Health Organ. 1999;77:560-56610444879Google Scholar
6.
Steffen R, Heusser R, Machler R.  et al.  Malaria chemoprophylaxis among European tourists in tropical Africa: use, adverse reactions and efficacy.  Bull World Health Organ. 1990;68:313-3222393977Google Scholar
7.
Jelinek T, Bluml A, Loscher T, Nothdurft H-D. Assessing the incidence of infection with Plasmodium falciparum among international travelers.  Am J Trop Med Hyg. 1998;59:35-379684623Google Scholar
8.
Askling HH, Nilsson J, Tegnell A, Janzon R, Ekdahl K. Risk of malaria in travelers returning from malaria endemic regions.  Emerg Infect Dis. 2005;11:436-44115757560Google ScholarCrossref
9.
Ross MH, Hodge M. Malaria in expatriate mine workers [poster paper]. In: Conference Proceedings of Minesafe International 2000. Perth, Australia: Minesafe; 2000:533-536
10.
Blanke CH. Increased malaria-morbidity of long-term travellers due to inappropriate chemoprophylaxis recommendations.  Trop Doct. 2003;33:117-11912680554Google Scholar
11.
Leutscher PD, Bagley SW. Health-related challenges in United States Peace Corps Volunteers serving for two years in Madagascar.  J Travel Med. 2003;10:263-26714531978Google ScholarCrossref
12.
Adera T, Wolfe MS, McGuire-Rugh K, Calhoun N, Marum L. Risk factors for malaria among expatriates living in Kampala, Uganda: the need for adherence to chemoprophylactic regimens.  Am J Trop Med Hyg. 1995;52:207-2127694960Google Scholar
13.
Peppiatt R, Byass P. A survey of the health of British missionaries.  Br J Gen Pract. 1991;41:159-1621854537Google Scholar
14.
Phillips-Howard PA, Radalowicz A, Mitchell J, Bradley DJ. Risk of malaria in British residents returning from malarious areas.  BMJ. 1990;300:499-5032107927Google ScholarCrossref
15.
Lange WR, Kreider SD, Kaczaniuk MA, Snyder FR. Missionary health: the great omission.  Am J Prev Med. 1987;3:332-3383452373Google Scholar
16.
McLarty DG, Webber RH, Marjatta Jaatinen LM.  et al.  Chemoprophylaxis of malaria in nonimmune residents in Dar es Salaam, Tanzania.  Lancet. 1984;2:656-6596147692Google ScholarCrossref
17.
Amexo M, Tolhurst R, Barnish G, Bates I. Malaria misdiagnosis: effects on the poor and vulnerable.  Lancet. 2004;364:1896-189815555670Google ScholarCrossref
18.
Causer LM, Filler S, Wilson M, Papagiotas S, Newman RD. Evaluation of reported malaria chemoprophylactic failure among travelers in a US University Exchange Program, 2002.  Clin Infect Dis. 2004;39:1583-158815578355Google ScholarCrossref
19.
Reyburn H, Mbatia R, Drakely C.  et al.  Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study [published online ahead of print November 12, 2004].  BMJ2004;329:1212. doi:10.1136/bmj.38251.658229.55. Accessed November 20, 2004.15542534Google Scholar
20.
Alweis RL, DiRosario K, Conidi G, Kain KC, Olans R, Tully JL. Serial nosocomial transmission of Plasmodium falciparum malaria from patient to nurse to patient.  Infect Control Hosp Epidemiol. 2004;25:55-5914756221Google ScholarCrossref
21.
Schlagenhauf-Lawlor P, Funk-Baumann M. PDQ Traveler's Malaria. Hamilton, Ontario: BC Decker; 2005
22.
Keiser J, Singer BH, Utzinger J. Reducing the burden of malaria in different eco-epidemiological settings with environmental management: a systematic review.  Lancet Infect Dis. 2005;5:695-70816253887Google ScholarCrossref
23.
Soto J, Medina F, Dember N, Berman J. Efficacy of permethrin-impregnated uniforms in the prevention of malaria and leishmaniasis in Colombian soldiers.  Clin Infect Dis. 1995;21:599-6028527550Google ScholarCrossref
24.
Lengeler C. Insecticide-treated bed nets and curtains for preventing malaria.  Cochrane Database Syst Rev. 2004;((2)):CD00036315106149Google Scholar
25.
Nasci R. Pre- and post-travel general health recommendations: protection against mosquitoes and other arthropods. In: Arguin PM, Kozarsky PE, Navin AW, eds. Health Information for International Travel, 2005-2006. Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 2005:24-28. http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=recs&obj=bugs.htm&cssNav=browseoyb. Accessed October 5, 2005
26.
 Insect repellents.  Med Lett Drugs Ther. 2003;45:41-4212766700Google Scholar
27.
McGready R, Hamilton KA, Simpson JA.  et al.  Safety of the insect repellent N,N-diethyl-m-toluamide (DEET) in pregnancy.  Am J Trop Med Hyg. 2001;65:285-28911693870Google Scholar
28.
American Academy of Pediatrics.  Follow safety precautions when using DEET on children. http://www.aap.org/family/wnv-jun03.htm. Accessed July 14, 2006
29.
Fradin MS, Day JF. Comparative efficacy of insect repellents against mosquito bites.  N Engl J Med. 2002;347:13-1812097535Google ScholarCrossref
30.
Frances SP, Van Dung N, Beebe NW, Debboun M. Field evaluation of repellent formulations against daytime and nighttime biting mosquitoes in a tropical rainforest in northern Australia.  J Med Entomol. 2002;39:541-54412061453Google ScholarCrossref
31.
Badolo A, Ilboudo-Sanogo E, Ouedraogo AP, Costantini C. Evaluation of the sensitivity of Aedes aegypti and Anopheles gambiae complex mosquitoes to two insect repellents: DEET and KBR 3023.  Trop Med Int Health. 2004;9:330-33414996361Google ScholarCrossref
32.
Frances SP, Waterson DG, Beebe NW, Cooper RD. Field evaluation of repellent formulations containing deet and picaridin against mosquitoes in Northern Territory, Australia.  J Med Entomol. 2004;41:414-41715185943Google ScholarCrossref
33.
Costantini C, Badolo A, Ilboudo-Sanogo E. Field evaluation of the efficacy and persistence of insect repellents DEET, IR3535, and KBR 3023 against Anopheles gambiae complex and other Afrotropical vector mosquitoes.  Trans R Soc Trop Med Hyg. 2004;98:644-65215363644Google ScholarCrossref
34.
Trigg JK. Evaluation of a eucalyptus-based repellent against Anopheles spp. in Tanzania.  J Am Mosq Control Assoc. 1996;12:243-2468827599Google Scholar
35.
Govere J, Durrheim DN, Baker L, Hunt R, Coetzee M. Efficacy of three insect repellents against the malaria vector Anopheles arabiensis.  Med Vet Entomol. 2000;14:441-44411129710Google ScholarCrossref
36.
Moore SJ, Lenglet A, Hill N. Field evaluation of three plant-based insect repellents against malaria vectors in Vaca Diez Province, the Bolivian Amazon.  J Am Mosq Control Assoc. 2002;18:107-11012083351Google Scholar
37.
Trongtokit Y, Curtis CF, Rongsriyam Y. Efficacy of repellent products against caged and free flying Anopheles stephensi mosquitoes.  Southeast Asian J Trop Med Public Health. 2005;36:1423-143116610644Google Scholar
38.
Harris AF, Matias-Arnez A, Hill N. Biting time of Anopheles darlingi in the Bolivian Amazon and implications for control of malaria.  Trans R Soc Trop Med Hyg. 2006;100:45-4716154607Google ScholarCrossref
39.
Govere J, Braack LE, Durrheim DN, Hunt RH, Coetzee M. Repellent effects on Anopheles arabiensis biting humans in Kruger Park, South Africa.  Med Vet Entomol. 2001;15:287-29211583446Google ScholarCrossref
40.
Durrheim DN, Govere JM. Malaria outbreak control in an African village by community application of “deet” mosquito repellent to ankles and feet.  Med Vet Entomol. 2002;16:112-11511963976Google ScholarCrossref
41.
Steffen R, Holdener F, Wyss RK, Nurminen L. Malaria prophylaxis and self-therapy in airline crews.  Aviat Space Environ Med. 1990;61:942-9451978665Google Scholar
42.
Public Health Agency of Canada.  Canadian recommendations for the prevention and treatment of malaria among international travellers: malaria prevention in the long-term traveller or expatriate.  Can Comm Dis Rep2004;30(suppl 1). http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/04vol30/30s1/page5_e.html. Accessed March 21, 2006Google Scholar
43.
Burdon J. Use of malarial prophylaxis amongst a population of expatriate church workers in Northeast Zaire.  J Travel Med. 1998;5:36-389772315Google ScholarCrossref
44.
Weber R, Schlagenhauf P, Amsler L, Steffen R. Knowledge, attitudes and practices of business travelers regarding malaria risk and prevention.  J Travel Med. 2003;10:219-22412946300Google ScholarCrossref
45.
Fradin MS. Mosquitoes and mosquito repellents: a clinician's guide.  Ann Intern Med. 1998;128:931-9409634433Google ScholarCrossref
46.
Parise M, Barber A, Mali S. Prevention of specific infectious diseases: malaria.  Health Information for International Travel, 2005-2006In: Arguin M, Kozarsky PE, Navin AW, eds. Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 2005:189-212. http://www2.ncid.cdc.gov/travel/yb/util/ybGetasap?section=disc&obj=index.htm&cssNav=browseoyb. Accessed October 5, 2006Google Scholar
47.
Chen LH, Keystone JS. New strategies for the prevention of malaria in travelers.  Infect Dis Clin North Am. 2005;19:185-21015701554Google ScholarCrossref
48.
Lobel HO, Miani M, Eng T, Bernard KW, Hightower AW, Campbell CC. Long-term malaria prophylaxis with weekly mefloquine.  Lancet. 1993;341:848-8518096560Google ScholarCrossref
49.
Overbosch D. Post-marketing surveillance: adverse events during long-term use of atovaquone/proguanil for travelers to malaria-endemic countries.  J Travel Med. 2003;(10 suppl 1)  S16-S20, S21-S2312737756Google Scholar
50.
Shanks GD, Roessler F, Edstein MD, Rieckmann KH. Doxycycline for malaria prophylaxis in Australian soldiers deployed to United Nations missions in Somalia and Cambodia.  Mil Med. 1995;160:443-4457478027Google Scholar
51.
Fryauff DJ, Baird JK, Basri H.  et al.  Randomized, placebo-controlled trial of primaquine for prophylaxis of falciparum and vivax malaria in Indonesia.  Lancet. 1995;346:1190-11937475658Google ScholarCrossref
52.
Pennie RA, Koren G, Crevoisier C. Steady state pharmacokinetics of mefloquine in long-term travellers.  Trans R Soc Trop Med Hyg. 1993;87:459-4628249080Google ScholarCrossref
53.
Rombo L, Angel VH, Friman G, Hellgren U, Mittelholzer ML, Sturchler D. Comparative tolerability and kinetics during long-term intake of Lariam and Fansidar for malaria prophylaxis in nonimmune volunteers.  Trop Med Parasitol. 1993;44:254-2568256106Google Scholar
54.
Steffen R, Fuchs E, Schildknecht J.  et al.  Mefloquine compared with other malaria chemoprophylactic regimens in tourists visiting East Africa.  Lancet. 1993;341:1299-13038098447Google ScholarCrossref
55.
Croft AM, World MJ. Neuropsychiatric reactions with mefloquine chemoprophylaxis.  Lancet. 1996;347:3268569381Google ScholarCrossref
56.
Schlagenhauf P, Lobel H, Steffen R.  et al.  Tolerance of mefloquine by SwissAir trainee pilots.  Am J Trop Med Hyg. 1997;56:235-2409080886Google Scholar
57.
Schlagenhauf P, Tschop A, Johnson R.  et al.  Tolerability of malaria chemoprophylaxis in non-immune travelers to sub-Saharan Africa: multicentre, randomized, double blind, four-arm study.  BMJ. 2003;327:1078-108314604928Google ScholarCrossref
58.
Wells TS, Smith TC, Smith B.  et al.  Mefloquine use and hospitalizations among US service members, 2002-2004.  Am J Trop Med Hyg. 2006;74:744-74916687673Google Scholar
59.
Peragallo MS, Sabatinelli G, Sarnicola G. Compliance and tolerability of mefloquine and chloroquine plus proguanil for long-term malaria chemoprophylaxis in groups at particular risk (the military).  Trans R Soc Trop Med Hyg. 1999;93:73-7710492796Google ScholarCrossref
60.
Hopperus Buma AP, van Thiel PP, Lobel HO.  et al.  Long-term malaria chemoprophylaxis with mefloquine in Dutch marines in Cambodia.  J Infect Dis. 1996;173:1506-15098648231Google ScholarCrossref
61.
Raoult D, Houpikian P, Dupont HT, Riss JM, Arditi-Djiane J, Brouqui P. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine.  Arch Intern Med. 1999;159:167-1739927100Google ScholarCrossref
62.
Baird JK, Lacy MD, Basri H.  et al.  Randomized, parallel placebo-controlled trial of primaquine for malaria prophylaxis in Papua, Indonesia.  Clin Infect Dis. 2001;33:1990-199711712091Google ScholarCrossref
63.
Chatterjee S. Compliance of malaria chemoprophylaxis among travelers to India.  J Travel Med. 1999;6:7-1110071366Google ScholarCrossref
64.
Fegan D, Glennon J. Malaria prophylaxis in long-term expatriate mineworkers in Ghana.  Occup Med (Lond). 1993;43:135-1388400208Google ScholarCrossref
65.
Dwelle TL. Inadequate basic preventive health measures: survey of missionary children in sub-Saharan Africa.  Pediatrics. 1995;95:733-7377724313Google Scholar
66.
Maarschalk T, Ross MH, de Frey AF. Attitudes, knowledge, beliefs and practices regarding malaria prophylaxis in expatriate mine workers in the Zambian Copperbelt.  Occupational Health Southern Africa. 2006;12:16-20Google Scholar
67.
Hamer DH, Ruffing R, Lyons S, Dornbusch J, Callahan MV. Use of antimalarial prophylaxis by expatriates at an industrial job site in West Africa [abstract]. Presented at: 8th Conference of the International Society of Travel Medicine; May 7-11, 2003; New York, NY
68.
World Health Organization.  Development of recommendations for the protection of short-stay travelers to malaria endemic areas: memorandum from two WHO meetings.  Bull World Health Organ. 1988;66:177-1963293826Google Scholar
69.
Schlagenhauf P, Steffen R. Stand-by treatment of malaria in travelers: a review.  J Trop Med Hyg. 1994;97:151-1608007055Google Scholar
70.
Schlagenhauf P, Steffen R, Tschopp A.  et al.  Behavioural aspects of travelers in their use of malaria presumptive treatment.  Bull World Health Organ. 1995;73:215-2217743593Google Scholar
71.
Nothdurft HD, Jelinek T, Pechel SM.  et al.  Stand-by treatment of suspected malaria in travelers.  Trop Med Parasitol. 1995;46:161-1638533018Google Scholar
72.
Lampe AS, Bakker RB, Smith SJ. Dangers of antimalarial standby treatment.  Eur J Clin Microbiol Infect Dis. 1994;13:3228070439Google ScholarCrossref
73.
Hatz C, Beck B, Blum J.  et al.  Supplementum 1: Malariaschutz für Kurzzeitaufenthalter. BAG Bull. March 2006. http://www.bag.admin.ch/themen/medizin/00682/00684/02535/index.html?lang=fr. Accessed July 23, 2006
74.
Behrens RH, Bisoffi Z, Bjorkman A.  et al.  Malaria prophylaxis policy for travellers from Europe to the Indian Subcontinent.  Malar J. 2006;5:716451728Google ScholarCrossref
75.
Weinke T, Trautmann M, Held T.  et al.  Neuropsychiatric side effects after the use of mefloquine.  Am J Trop Med Hyg. 1991;45:86-911867351Google Scholar
76.
Phillips-Howard PA, Behrens RH, Dunlop J. Stevens-Johnson syndrome due to pyrimethamine/sulfadoxine during presumptive self-therapy of malaria.  Lancet. 1989;2:803-8042571042Google ScholarCrossref
77.
US Centers for Disease Control and Prevention (CDC).  Sudden death in a traveler following halofantrine administration—Togo, 2000.  MMWR Morb Mortal Wkly Rep. 2001;50:169-170, 17911393488Google Scholar
78.
Trachsler M, Schlagenhauf P, Steffen R. Feasibility of a rapid dipstick antigen-capture assay for self-testing of travellers' malaria.  Trop Med Int Health. 1999;4:442-44710444320Google ScholarCrossref
79.
Funk M, Schlagenhauf P, Tschopp A, Steffen R. MalaQuick versus ParaSight F as a diagnostic aid in travellers' malaria.  Trans R Soc Trop Med Hyg. 1999;93:268-27210492756Google ScholarCrossref
80.
Grobusch MP, Hanscheid T, Gobels K.  et al.  Comparison of three antigen detection tests for diagnosis and follow-up of falciparum malaria in travellers returning to Berlin, Germany.  Parasitol Res. 2003;89:354-35712632146Google Scholar
81.
Whitty CJM, Armstrong M, Behrens RH. Self-testing for falciparum malaria with antigen-capture cards by travelers with symptoms of malaria.  Am J Trop Med Hyg. 2000;63:295-29711421381Google Scholar
82.
Jorgensen P, Chanthap L, Rebueno A, Tsuyuoka R, Bell D. Malaria rapid diagnostic tests in tropical climates: the need for a cool chain.  Am J Trop Med Hyg. 2006;74:750-75416687674Google Scholar
83.
Aldhous P. Murder by medicine.  Nature. 2005;434:132-13615758966Google ScholarCrossref
84.
Cockburn R, Newton PN, Agyarko EK, Akunyili D, White NJ. The global threat of counterfeit drugs: why industry and governments must communicate the dangers.  PLoS Med. 2005;2:e10015755195Google ScholarCrossref
85.
Newton PN, McGready R, Fernandez F.  et al.  Manslaughter by fake artesunate in Asia—will Africa be next?  PLoS Med. 2006;3:e19716752952Google ScholarCrossref
86.
Newton PN, Green MD, Fernandez FM, Day NPJ, White NJ. Counterfeit anti-infective drugs.  Lancet Infect Dis. 2006;6:602-61316931411Google ScholarCrossref
87.
Knobloch J. Long-term malaria prophylaxis for travelers.  J Travel Med. 2004;11:374-37815569575Google ScholarCrossref
88.
Muhlberger N, Jelinek T, Gascon J.  et al.  Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop.  Malar J. 2004;3:515003128Google ScholarCrossref
89.
Schwartz E, Sidi Y. New aspects of malaria imported from Ethiopia.  Clin Infect Dis. 1998;26:1089-10919597233Google ScholarCrossref
90.
Schwartz E, Parise M, Kozarsky P, Cetron M. Delayed onset of malaria—implications for chemoprophylaxis in travelers.  N Engl J Med. 2003;349:1510-151614561793Google ScholarCrossref
91.
Elliott JH, O’Brien D, Leder K.  et al.  Imported Plasmodium vivax malaria: demographic and clinical features in nonimmune travelers.  J Travel Med. 2004;11:213-21715541223Google ScholarCrossref
92.
Filler S, Causer LM, Newman RD.  et al.  Malaria surveillance—United States, 2001.  MMWR Surveill Summ. 2003;52:1-1412875252Google Scholar
93.
Eliades MJ, Shah S, Nguyen-Dinh P.  et al.  Malaria surveillance—United States, 2003.  MMWR Surveill Summ. 2005;54:25-3915931154Google Scholar
94.
Skarbinski J, Eliades MJ, Causer LM.  et al.  Malaria Surveillance—United States, 2004.  MMWR Surveill Summ. 2006;55:23-3716723971Google Scholar
95.
Funk-Baumann M. Geographic distribution of malaria at traveler destinations. In: Schlagenhauf-Lawlor P, ed. Travelers' Malaria. Hamilton, Ontario: BC Decker; 2001:56-93
96.
Edgcomb JH, Arnold J, Yount EH Jr.  et al.  Primaquine, SN 13272, a new curative agent in vivax malaria: a preliminary report.  J Natl Malar Soc. 1950;9:285-29214804087Google Scholar
97.
Garrison PL, Hankey DD, Coker WG.  et al.  Cure of Korean vivax malaria with pamaquine and primaquine.  J Am Med Assoc. 1952;149:1562-156314945979Google ScholarCrossref
98.
Hill DR, Baird K, Parise ME, Lewis LS, Ryan ET, Magill AJ. Primaquine: report from CDC Expert Meeting on Malaria Chemoprophylaxis.  Am J Trop Med Hyg. 2006;75:402-41516968913Google Scholar
99.
Jelinek T, Nothdurft HD, Von Sonnenburg F, Loscher T. Long-term efficacy of primaquine in the treatment of vivax malaria in nonimmune travelers.  Am J Trop Med Hyg. 1995;52:322-3247741169Google Scholar
100.
Alving AS, Arnold J, Hockwald RS.  et al.  Potentiation of the curative action of primaquine in vivax malaria by quinine and chloroquine.  J Lab Clin Med. 1955;46:301-30613242948Google Scholar
Clinical Review
November 8, 2006

Prevention of Malaria in Long-term Travelers

Author Affiliations
 

Clinical Review Section Editor: Michael S. Lauer, MD. We encourage authors to submit papers for consideration as a Clinical Review. Please contact Michael S. Lauer, MD, at lauerm@ccf.org.

 

Author Affiliations: Mount Auburn Hospital, Cambridge, Mass (Drs Chen and Wilson); Harvard Medical School (Drs Chen and Wilson) and Harvard School of Public Health (Dr Wilson), Boston, Mass; and University of Zürich, World Health Organization Collaborative Center for Travelers' Health, Zürich, Switzerland (Dr Schlagenhauf).

JAMA. 2006;296(18):2234-2244. doi:10.1001/jama.296.18.2234
Abstract

Context Long-term travelers, defined here as those traveling for periods of 6 months or longer, face particular challenges regarding malaria prevention. Current guidelines for malaria prevention primarily address prevention of Plasmodium falciparum infections in short-term travelers.

Objectives To examine the risk of malaria in long-term travelers, recent developments in personal protective measures, and the safety and tolerability of malaria chemoprophylaxis during long-term use and to consider prevention strategies including continuous chemoprophylaxis, stand-by emergency self-treatment, seasonal prophylaxis, and strategies to prevent primary infection and relapses from P vivax malaria.

Evidence Acquisition Comprehensive search of scientific publications including MEDLINE via both OVID and PubMED for relevant studies and articles with a cutoff date of July 2006, using the search terms long-term travel and malaria prevention, long-term malaria chemoprophylaxis, and insect repellent and malaria. Additional references were obtained from searching the bibliographies of the selected articles, from dissertations, and from the proceedings of relevant conferences on travel medicine. There were no language restrictions.

Evidence Synthesis Long-term travelers have a higher risk of malaria than short-term travelers. Long-term travelers underuse personal protective measures and adhere poorly to continuous chemoprophylaxis regimens. A number of strategies are used during long-term stays: discontinuation of chemoprophylaxis after the initial period, sequential regimens with different medications for chemoprophylaxis, stand-by emergency self-treatment, and seasonal chemoprophylaxis targeting high-incidence periods or locations. All strategies have advantages and drawbacks. Counterfeit drugs sold in countries endemic for malaria pose serious concern for long-term travelers who purchase their medications overseas. Vivax malaria causes significant illness in travelers, but relapses of vivax malaria are not prevented with the current first-line chemoprophylaxis regimens. Consensus guidelines are needed for prevention of malaria in long-term travelers.

Conclusions Prevention of malaria in long-term travelers is a complex issue and requires expert advice from travel medicine specialists. Recommendations for prevention of malaria in long-term travelers must be individualized.

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